LILY PARK (D.O.) – Dermatology Physician, NPI 1124333455
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
232 DERMATOLOGY in OR
Provider Addresses for LILY PARK (D.O.)
1390 Waverly Dr SE
Albany, OR 973226958
Phone: (503) 362-8385
Type: Location
3105 CEDAR RAVINE RD
STE 201
PLACERVILLE, CA 956676561
Phone: (530) 626-1602
Type: Mailing
600 COFFEE RD
MODESTO, CA 953554201
Phone: (209) 521-6097
Type: Location
600 Coffee Rd
Modesto, CA 953554201
Phone: (209) 521-6097
Type: Location
375 SE Norton Ln Ste C
McMinnville, OR 971288484
Phone: (503) 362-8385
Fax: (503) 362-8435
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 100 Open Payments records for all available years, with a total value of $3,881.
Total Amount is formed as General ($3,881) + Research ($0) + Ownership ($0) = $3,881.
Last reported payment date: 2024-12-10 • Largest payer in this snapshot: Janssen Biotech, Inc. ($761).
Total Amount
$3,881
General + Research + Ownership
Payments
100
Total payment records
General Amount
$3,881
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-10
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Janssen Biotech, Inc. | $761 |
| ABBVIE INC. | $676 |
| E.R. Squibb & Sons, L.L.C. | $291 |
| PFIZER INC. | $211 |
| Amgen Inc. | $211 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2014-02-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20140203001252 | I | Dermatology | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97322)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Registered Dietitian Or Nutrition Professional | CA | |
| Cardiovascular Disease (Cardiology) | CA | |
| H E M A T O L O G Y/ O N C O L O G Y | CA | |
| Cardiovascular Disease (Cardiology) | CA | |
| Physical Therapist In Private Practice | CA | |
| Family Practice | CA | |
| U R O L O G Y | CA | |
| - | CA | |
| Physical Therapist In Private Practice | CA | |
| O P T O M E T R Y | CT |
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